Pediatrics

• Develop, implement, and evaluate standards of diagnostic techniques and treatment strategy based on contemporary protocols.
• Develop, implement, and evaluate standards related to support of care needs such as blood product's support, management of fever, and management of neutropenia.

• Two Russian physicians traveled to Memphis in February for a three-month internship at St. Jude Children's Research Hospital. They participated in patient care rounds on the leukemia/lymphonma, solid tumor, and bone marrow transplant units. They were also able to attend conferences, take part in library research, and were also given the opportunity to meet one-on-one with experts in the field.
• A videoconference between Methodist Hospital and representatives of the Moscow partnership hospital was held in March. Partners communicated about future trips and workplan issues.
• On October 13, the partners held another videoconference, this time for over 100 US physicians and 10 NIS participants. The topic was acute lymphoblastic leukemia. The US physicians presented a case and then offered a lecture with a discussion following. The Moscow participants then selected a case that they presented and discussed.
• A third videoconference was held between Memphis and Moscow on December 1 to discuss management of infections.
• In October, the Advisory Board Foundation in Washington, DC donated 40 vials of ATGAM and 500 vials of Amikacin worth $67,000 for pediatric cancer patients at the Institute for Pediatric Hematology.
  

Pediatrics

• After discussions with investigators at the Republican Children's Hospital, the partners decided to extend the preliminary study of the non-Hodgkin Lymphomas in Russia. The initial project resulted in a manuscript which has been submitted for publication.
• Russian partners successfully completed short-term, mini-fellowships in Memphis, focusing on their specific areas of interest, including Pediatric Hematology/Oncology, Bone Marrow Transplantation and Allergy/Immunology. Their knowledge base in their respective areas of study was greatly enhanced, permitting them not only to provide a higher quality of care, but also to serve as mentors for junior faculty in their institution. By observing the diagnostic laboratory evaluation of patients with suspected acute leukemia, including making the initial bone marrow smears and review of morphology and special stains, the Russian partners gained valuable skills in diagnostic approach to patients with newly diagnosed acute leukemia. They also had the opportunity to participate in the work-up of patients with newly diagnosed malignant lymphoma. Specifically, they were able to review with specialist in the field, the appropriate diagnostic steadies to obtain guidance as to how to classify their findings. All this information was then used to review how specific treatments were selected and implemented.
• The physicians also received training on the management of infectious complications in children who are immuno-compromised. Specifically, the institutional guidelines for the management of fever and neutropenia, which closely parallels the recommendations in the AIHA Infection Manual, were reviewed with the visiting scientists. They had opportunities to discuss these strategies both on inpatient rounds as well as on a one-to-one basis. This topic was chosen for one of the three teleconferences held between St. Jude Children's Research Hospital and the Scientific Research Institute of Pediatric Hematology.
• For each of the malignancies discussed above, there was significant time spent on how a treatment plan is selected. For acute leukemia, this was based on both the subtype of leukemia diagnosed and on the clinical and biological risk factors. For those who presented with malignant lymphoma, the histologic and stage direct approach to management was extensively reviewed.
• Although the management of allergenic/immunologic disorders in children was not a specific goal of the partnership program, two of the fellows were able to spend an extensive amount of time in clinics pertaining to these disorders. Specifically, they were able to learn much about congenital immune deficiencies as well as acquired allergic/immunologic disorders. Principles pertaining to the management of infections in children with cancer are clearly pertinent in the management of children with immuno-deficiency disorders and infections.